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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 2/8/2017 <br /> Submitted on: 2/3/2017 3:03:17PM CERS ID: 10181967 <br /> Submitted by: Prabjot Bajwa Email: psbajwa@live.com Facility ID in CERS: FA0005880 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0004681 <br /> Owner name PS BAJWA INC Manjit Singh 111 <br /> Mailing address 601 S VENTURA ST 3746 Canyonlands Rd 113 <br /> STOCKTON, CA 95203 Stockton, CA 95209 114, 115, 116 <br /> Work phone 209-467-1195 2094010944 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005880 <br /> Facility name PS BAJWA INC PS Bajwa Inc. 3 <br /> Site address 601 S VENTURAAVE 601 S VENTURAAVE 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95203 95203 105 <br /> Facility phone 209-467-1195 2094671195 102 <br /> Facility mailing address 601 S VENTURAAVE 601 S Ventura Ave 108a <br /> STOCKTON, CA 95203 Stockton, CA 95203 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name PS BAJWA INC Prabjot Singh Bajwa 140 <br /> Address 601 S VENTURAAVE 601 S Ventura Ave 143 <br /> STOCKTON, CA 95203 Stockton, CA 95203 144, 145, 146 <br /> Contact phone Not Specified 2094706062 141 <br /> Contact email psbajwa@live.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: 'Mvs 1 ( g <br /> created [ ] Tiered permit XAPSA [ ] CalARP [ ] UST New PE: 2$31 <br /> Assigned to: Q-\V <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year It ]'exempt from billing <br /> Processed through CERS Integration Wizard by: l/v"] Date: 2 <br /> ---------------,,—``------------------------ - <br /> Accounting: Reviewed by: (.7/ Date: -14;9 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> ---- ( �q cctbilled Surcharge verified ---By:— Date: <br /> P --- -------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials 2 chem units PR0520974 ROBERT LOPEZ Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO541541 STACY RIVERA Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0517607 HAZ MAT SJC OES Inactive ( ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0503560 MICHAEL KITH Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO517611 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524627 JENNIFER FRASE Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531781 not assigned Inactive [ ] [ ] <br />